Individual
JEWELL V GAULDING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2123 AUBURN AVE, CINCINNATI, OH 45219-2906
(513) 579-9191
(513) 579-0350
Mailing address
237 WILLIAM HOWARD TAFT RD, CBO2-3, ATTN: CREDENTIALING, CINCINNATI, OH 45219-2610
(513) 263-8571
(513) 263-8622
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
35.139263
OH
207N00000X
Dermatology Physician
MD465287
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0405664
—
OH
01
—
14326145
CAQH
PA
05
—
PENDING
—
PA
Enumeration date
04/23/2014
Last updated
11/24/2020
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